Up until now, real-world evidence on treatment adherence for JAK inhibitors is primarily available for tofacitinib, scarce for baricitinib, and non-existent for upadacitinib.

This large observational, population-based analysis, involving 4,500 rheumatoid arthritis patients from a random Australia wide sample, is the first to conduct a head-to-head comparison between the different JAK inhibitors baricitinib, tofacitinib, and upadacitinib, and other biologic DMARDs.

We showed superior persistence rates for upadacitinib, followed by baricitinib and then tofacitinib and TNFi therapy. The superior persistence rate for upadacitinib remained consistent regardless of line of treatment and use of comedication.

This study calls for head-to-head comparison between the different JAK inhibitors to better understand treatment effectiveness, safety, and tolerability in ‘real-world practice’.

To compare persistence of disease-modifying antirheumatic (DMARDs), with a focus on Janus kinase (JAK) inhibitors in Australian rheumatoid arthritis (RA) patients.

A retrospective observational study was conducted among 4,521 RA patients (females n=3,181 [70.4%]), using data from the Services Australia 10% Pharmaceuticals Benefits Scheme (PBS) dataset, aged ≥18 years and initiating a DMARD between 2011 to 2021. Kaplan-Meier analysis was used to estimate persistence rates, defined as occurrence of 6 months gap after the end of a drug dispensing.

Twelve-month persistence rates were 72% for upadacitinib, 61% for baricitinib, 58% for subcutaneous tumor necrosis factor-alpha inhibitors (TNFi), 55% for tocilizumab, 53% for tofacitinib, and 49% for abatacept. Median treatment persistence was not reached for upadacitinib (n=574) and baricitinib (n=553); and was 15.0 months for tofacitinib (95% CI 13.5–19.5), 20.5 months for TNFi (95% CI 19.0–22.4), 19.1 months for tocilizumab (95% CI 17.9–23.6), and 12.5 months for abatacept (95% CI 10.4–14.9). Persistence rates on first-line JAK inhibitors were 68% for upadacitinib and baricitinib and 55% for tofacitinib, and 49% for TNFi, 55% for abatacept, and 57% for tocilizumab; rates were sustained for upadacitinib, TNFi, and tocilizumab but dropped to 59% for baricitinib and 47% for abatacept in the second-line treatment. For each b/tsDMARD, persistence rates were higher when combined with methotrexate or other conventional synthetic DMARDs. The median oral glucocorticoid dose decreased from 4.3 mg/day (range:0–40) to 2.3 mg/day (range:0–22) over 2 years. Changes were significant for all RA DMARDs, tofacitinib and baricitinib combined (1–2 years post initiation only), TNFi, abatacept, and tocilizumab.

In a real-world setting, we showed highest persistence rates on upadacitinib, followed by baricitinib and then TNFi therapy and was improved by co-therapy. All agents appeared to be corticosteroid sparing.

Rheumatoid arthritis

Janus kinase inhibitors

Baricitinib

Tofacitinib

Upadacitinib

Persistence

Discontinuation

DMARD

Glucocorticoids

Effectiveness

© 2023 The Authors. Published by Elsevier Inc.